Missouri Respiratory Therapist License 2026: Step-by-Step Guide

How to Become a Licensed Respiratory Therapist in Missouri

Missouri mandates state licensure for all practicing respiratory therapists. The Missouri Division of Professional Registration (under the Department of Commerce and Insurance) oversees the RT licensing program. The process flows from CoARC-accredited education through NBRC credentialing to the state application — all manageable with good planning. Here is the complete 2026 roadmap.

Step 1: Complete a CoARC-Accredited Respiratory Therapy Program

Missouri has a strong network of accredited programs. Institutions offering CoARC-accredited respiratory therapy curricula include Missouri State University, Sanford-Brown College's St. Louis campus programs, and community colleges such as Ozarks Technical Community College (OTC) in Springfield and St. Louis Community College. Both AAS and bachelor's completion pathways are available.

Missouri's two major metros — Kansas City and St. Louis — each have multiple clinical training sites affiliated with large health systems, giving students access to high-acuity rotations in adult ICU, cardiac care, NICU, and pediatric units during their programs.

Step 2: Pass the NBRC Examinations

NBRC credentials are the gateway to Missouri licensure:

• TMC Exam — Administered by Pearson VUE. Passing at the CRT cut score earns the CRT credential; passing at the higher RRT cut score (combined with passing the CSE) earns the RRT.
• Clinical Simulation Exam (CSE) — Required to complete the RRT pathway.

Missouri requires the RRT for licensure. Pearson VUE has testing centers in Kansas City, St. Louis, and Springfield. NBRC provides credential verification letters directly to state boards, but you can also download an official verification document through your NBRC account.

Step 3: Apply for Your Missouri License

Apply through the Missouri Division of Professional Registration's online portal at pr.mo.gov. Required documentation includes:

• Official transcript confirming CoARC-accredited program graduation
• NBRC official credential verification (RRT required)
• Completed state application with background disclosure
• Application fee of approximately $50–$75 (confirm current fee schedule at pr.mo.gov)

Standard processing takes two to four weeks. Missouri does offer endorsement pathways for applicants already licensed in other states, provided the originating state had equivalent or stricter requirements. Contact the Division directly to confirm eligibility before submitting a full new application.

CRT vs. RRT: Which Do You Need in Missouri?

Missouri requires the RRT credential for state licensure. The CRT alone does not satisfy Missouri's licensing statute. Both major Missouri markets — Kansas City and St. Louis — run high-acuity health systems that operate ICUs, transplant programs, and trauma services, making the RRT not just a legal requirement but a practical necessity for the scope of work most Missouri RTs perform.

Continuing Education Requirements

Missouri requires 30 hours of continuing education every two years for license renewal. CE must be relevant to respiratory care practice. Acceptable sources include:

• AARC-approved programs and modules
• Missouri Society for Respiratory Care (MSRC) chapter events and the annual Missouri Respiratory Care Conference
• Hospital-based in-service training (check Division rules for pre-approved formats)
• NBRC Continuing Competency activities

Missouri's biennial renewal cycle aligns with your license expiration date. Retain proof of completion for all CE activities for a minimum of four years.

Missouri Respiratory Therapist Salary Ranges

Missouri salaries vary meaningfully by market:

• Entry-level (0–2 years): $47,000–$57,000/year
• Mid-career (3–8 years): $57,000–$70,000/year
• Senior/specialty RTs: $70,000–$82,000/year
• Travel RT (13-week contracts in MO): $1,900–$2,700/week all-in

Kansas City and St. Louis both pay above the state median, with St. Louis Metro slightly higher due to the density of academic and quaternary-care facilities. Springfield, Columbia, and other secondary markets pay competitively relative to local cost of living.

Top Employers

• BJC HealthCare (St. Louis) — One of Missouri's largest health systems; anchored by Barnes-Jewish Hospital (the state's only Level I trauma center on the Missouri side), Washington University physicians, and St. Louis Children's Hospital for pediatric/neonatal RT roles.
• Mercy (Springfield/St. Louis) — Large Catholic health system with hospitals across Missouri; consistent RT hiring in multiple markets.
• SSM Health (St. Louis/Kansas City) — Multi-hospital system with high ICU census; strong RRT utilization in ventilator and cardiac care units.
• University Health (Kansas City) — Safety-net academic medical center serving the KC metro; Level I trauma and Level IV NICU with advanced RT scope.
• Cerner/Oracle Health-area employers — Kansas City's health-tech ecosystem creates ancillary demand for clinically experienced RTs in informatics and clinical specialist roles.